Article Text

C-Reactive Protein in Acute Pulmonary Embolism
  1. Yasin Abul, MD*,
  2. Sait Karakurt, MD,
  3. Beste Ozben, MD,
  4. Ahmet Toprak, MD§,
  5. Turgay Celikel, MD
  1. From the *Ministry of Health Bismil Government Hospital, Pulmonary Medicine Clinics, Diyarbakir; †Departments of Pulmonary and Critical Care, and ‡Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey; and §Tulane Center for Cardiovascular Health, New Orleans, LA.
  1. Received June 29, 2010, and in revised form October 2, 2010.
  2. Accepted for publication October 2, 2010.
  3. Reprints: Beste Ozben, MD, Yildiz Caddesi Konak Apartmani, No. 43/24 Besiktas 34353 Istanbul/Turkey. E-mail: besteozben{at}
  4. No funding or grant was received for this study.
  5. Author contributions: Dr. Abul was the principal investigator of the study and was responsible for the design of the study, data collection and analysis, and drafting of the article. Dr. Karakurt also was responsible for the design of the study and revised the article. Dr. Ozben was responsible for the data analysis and drafting of the article. Dr. Toprak also helped in data interpretation and revised the manuscript. Dr. Celikel critically revised and approved the article.


Background Right ventricular dysfunction and N-terminal proB-type natriuretic peptide (NT-proBNP) are established determinants of prognosis in acute pulmonary embolism (PE). The aim of the study was to investigate the prognostic value of C-reactive protein (CRP) in PE.

Methods Fifty-six patients (mean age, 64.4 ± 14.8years; 22 male subjects) with acute PE were consecutively enrolled and followed for 36 months after discharge. Serum CRP, NT-proBNP, and troponin T levels were determined. Right ventricular function was evaluated by transthoracic echocardiography.

Results Right ventricular dysfunction was present in 31 patients and was more frequent in patients with higher CRP and NT-proBNP levels (P = 0.020 and P = 0.045, respectively). During the 36-month follow-up, there were 15 terminal events (death due to recurrent PE). The mortality rate was 41.2% in patients with NT-proBNP levels greater than 1000 pg/mL, whereas it was 5.9% in patients with less than 500 pg/mL (P = 0.011). Mortality rates also were higher in patients with elevated CRP and troponin T levels, but the differences did not reach clinical significance. The survival rate of acute PE patients with lower NT-proBNP and CRP levels was better than that of patients with higher NT-proBNP and CRP levels. Receiver operating characteristic curve analysis demonstrated cutoff values for NT-proBNP as 1800 pg/mL (sensitivity, 93.3%; specificity, 68.2%; positive predictive values, 66.7%; and negative predictive values, 93.8%) and for CRP as 48mg/L (sensitivity, 72.7%; specificity, 61.9%; positive predictive values, 50.0%; and negative predictive values, 81.3%) to predict mortality in PE patients.

Conclusions C-reactive protein is associated with right ventricular dysfunction, which is a predictor of prognosis in PE and may become a promising biomarker for risk stratification of PE, although CRP is not found superior to NT-proBNP.

Key Words
  • C-reactive protein
  • inflammation
  • N-terminal proB-type natriuretic peptide
  • prognosis
  • pulmonary embolism
  • right ventricular dysfunction
  • survival

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